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Flu Vaccination Coverage on the Rise but Health Officials Urge Continued Vigilance

Sep 26, 2013

More children than ever are getting vaccinated to protect against influenza, according to new data announced by U.S. health officials at a news conference today held by the National Foundation for Infectious Diseases (NFID). But this news is not slowing down health experts annual call for increased vaccination, especially following last years early and severe flu season.

The latest influenza vaccination coverage estimates among children and adults were announced by Howard K. Koh, MD, assistant secretary for health at the U.S. Department of Health and Human Services (HHS) and Anne Schuchat, MD, (RADM, USPHS), assistant surgeon general, U.S. Public Health Service, and director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC). They both note that the increasing coverage is reassuring, but still falls short of public health goals.

The influenza vaccination data, collected and reported by the CDC, were published in this weeks issue of CDCs Morbidity and Mortality Weekly Report and online at FluVaxView Large increases were seen in vaccination coverage during the 2012-2013 season for children age 6 months through 17 years last season with coverage at 56.6 percent, up 5.1 percentage points from the 2011-12 season. Smaller increases were reported in adults 18 years and older at 41.5 percent, up 2.7 percentage points from the 2011-12 season. In total, 45 percent of the entire U.S. population age 6 months and older was vaccinated during the 2012-13 season.

Koh pointed out that the gains do not mean the work is done. Despite substantial progress, we can do even more to make our country healthier through prevention. Flu vaccination should represent a simple investment we make year in and year out to maximize the gift of health.

Vaccination coverage among those age 6 months and older varied across states with a 23 percent gap from the highest statewide rate (56.7 percent) to lowest (34.1 percent). Although vaccination coverage is much higher in pregnant women than just a few years ago, unlike other groups where rates continue to increase, coverage in pregnant women appears to have stalled at around 50 percent. While influenza vaccination coverage is on the rise in almost all racial and ethnic groups, differences still exist. The traditional ethnic/racial disparities are not seen among children. However only slightly more than half of children are getting a vaccination and disparities remain among adults, with coverage among adult blacks (36 percent) and Hispanics (34 percent) far lower than their white counterparts (45 percent).

Koh and Schuchat joined William Schaffner, MD, immediate past-president of NFID, and other leading medical experts at the National Press Club in Washington, D.C. to urge everyone 6 months and older to get vaccinated every year.

Vaccination coverage was highest in the over 65 age group (66 percent), for whom vaccination has been recommended the longest, and young children (70 percent in those 6 months to 4 years of age) who receive many vaccines from pediatricians as part of their routine healthcare. But it is the increase in the historically tougher to reach 18 to 49 age group that particularly pleases health officials. Among adults 18-49 years old, influenza vaccination coverage was 2.5 percentage points higher during the 2012-2013 season (31 percent) compared to the 2011-2012 season. The message appears to be getting through to this group, the last to be added as the U.S. finalized its universal recommendation in 2010 for annual flu vaccine for everyone 6 months of age and older.

The CDC also reports that a record high of 72 percent of healthcare personnel got an influenza vaccination last year.

If you are around people at high risk for flu complications, you need to get vaccinated, says Schuchat. And nowhere is this need clearer than in our nations hospitals, clinics and long-term care facilities.

Schuchat noted that while coverage has been increasing annually in most healthcare occupational settings, this is not the case for long-term care facilities, where coverage has gone up and down and remained low (59 percent) compared with hospitals (83 percent).

Among healthcare personnel, physicians have the highest coverage of influenza vaccination at 92.3 percent, but coverage increased in all healthcare occupations. Pharmacists, physician assistants, nurses and nurse practitioners all had coverage well above 80 percent. Among non-clinical personnel, including food service workers, maintenance, housekeeping and administrative staff, coverage was the lowest at 64.8 percent.

Patients also look to you. Data show that a personal recommendation makes a big difference to patients, says Schuchat. For example, pregnant women whose physicians recommend flu vaccination are five times more likely to get vaccinated. Schuchat also reminded healthcare professionals that they should begin vaccinating patients as soon as vaccine is available in their area.

Richard Liebowitz, MD, senior vice president and chief medical officer at New York-Presbyterian Hospital in New York City, leads vaccination efforts for employees at the nations largest not-for-profit hospital. We are committed to vaccinating our staff in order to protect our patients," he says. "This is priority one. Patients come to us to improve their health and we need to do all we can to shield them from exposure to the influenza virus. The added benefits from flu immunization keep our employees and their families healthy, and of course, enable staff to care for our patients during winter respiratory season."

About 135 million influenza vaccine doses will be available this year in doctors offices, public health clinics, hospitals, pharmacies, retail stores, workplaces and other venues. In addition to the standard injected vaccine, there is a high-dose version for people 65 years and older and a version made in cell-culture, a technique long-used for other vaccines, but new for influenza. There is also a vaccine with a much smaller needle for adults 18 through 64 years old; an egg-free version for adults 18 through 49 years old; and the nasal spray, a needle-free option for those 2 through 49 years old. In addition, for the first time this year some of the vaccines available will provide protection against four strains of influenza.

We have more types of vaccine available than ever before, and there are one or more options that are right for everyone, says Schaffner. While the plan is for all vaccines to eventually include four strains compared to the long-standing three, Dr. Schaffner said this is not expected to happen for several years. In the interim, he stressed that getting vaccinated is so important that no one should skip vaccination if his or her first choice is not available.

Schaffner also noted that the vaccine cannot cause the flu, despite a common misconception which may keep some people from getting vaccinated. It takes up to two weeks for the bodys full response to vaccination. In the meantime, if a person comes in contact with someone infected with flu, he or she might get sick. Because people can spread the virus for a few days before symptoms appear, one may not know theyve already been infected. According to Schaffner, people often confuse influenza with other winter or stomach viruses.

Schaffner also urged people to be aware of pneumococcal infection, a common complication of influenza that can cause a particularly severe type of pneumonia, as well as meningitis, blood poisoning and other serious infections. Influenza season is also a good time for patients to ask about whether they need pneumococcal vaccination. Pneumococcal vaccination is recommended for everyone 65 years and older. Younger adults may need it if they have certain risk conditions, such as heart, lung or liver problems, diabetes, asthma or are smokers. Vaccination is also very important for people with compromised immune systems, which can result from HIV infection and many types of cancer.

The impact of influenza and the importance of vaccination were echoed by Paul Biddinger, MD, medical director for emergency preparedness at Massachusetts General Hospital in Boston. Biddinger was on the frontlines in Boston during last years severe flu outbreak that caused the city to declare a public health emergency after 700 diagnoses and four deaths in early January. Bostons emergency departments, like so many across the country, were stretched beyond capacity dealing with influenza cases. Last year started with an especially early season with a large number of severe cases presenting together over a short time, but every year we see many patients in our emergency department who struggle to fight off influenza. Dont wait until you hear about an outbreak in your area. Get vaccinated now to protect yourself, those around you, and your community.

This years vaccine will protect against three viral strains most likely to cause the flu in the upcoming year: A/California/7/2009 (H1N1) pdm09-like virus; A(H3N2) virus antigenically like the cell-propagated prototype virus A/Victoria/361/2011; and B/Massachusetts/2/2012-like virus. All of the nasal spray vaccine and some other types of vaccine will also include a second influenza B strain, B/Brisbane/60/2008-like virus. While vaccination is the best way to prevent influenza, CDC outlined its three-step approach to fighting the flu. In addition to getting vaccinated, CDC urges everyday preventive actions such as hand washing and cough hygiene, and for those who do get infected, appropriate use of antiviral drugs as prescribed by a healthcare professional. The antivirals, oseltamivir or zanamivir, can help reduce the risk of serious influenza complications.

At the news conference, NFID called on healthcare professionals, business and community leaders to lead by example, by making influenza prevention a health priority. Koh and other panel members were vaccinated at the conference. NFIDs Leading by Example is supported by more than 30 companies and organizations that have signed on to a commitment statement to show their support.